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Yes. Over the last few decades, urologists have figured out that low-grade prostate cancer grows really, really slowly. So slowly, in fact, that we can actually follow these low-grade cancers with serial prostate biopsies and now with prostate MRIs. As you can tell from the Gleason grading score, low-grade is Gleason grade 3, and the score is Gleason score (3+3). This simply means that no grade higher than 3 was found in that area of the prostate, and Gleason 3 cancer routinely grows very slowly. Learn more on the prostate cancer grading here.
Almost all. Although most Gleason 3 cancers are slow-growing, there are a few that may have more aggressive features while still fitting into the criteria of a Gleason grade 3 prostate cancer. To help differentiate the wolves from the sheep, there are a few genetic tests out there that literally unpack the cancer and look inside. Examples of these tests include Prolaris, Oncotype DX, and Decipher.
Dr. Rich Bevan-Thomas works very closely with Dr. Adam Cole (Urology Partners pathologist) who helps with guidance for these tests. Dr. B-T believes that pathology is among the most important aspects of prostate cancer, especially now that we use active surveillance. Dr. Cole will evaluate the cells under the microscope and grade the cancer. He will also look for clues that the cancer has more concerning features. In that case, a secondary genetic test will be ordered.
Not exactly. It is still important to monitor your prostate cancer. Yes, it is true that low-grade cancers grow slowly, and it is helpful to have a genetic evaluation, but there is always the possibility that there is a higher-grade cancer lurking nearby.
This is exactly why Dr. B-T recommends a prostate MRI at some point within three to six months either before or after your prostate cancer diagnosis. Prostate MRIs are not foolproof, but they have a roughly 85% chance of finding a higher-grade cancer if it is present in the prostate. Dr. B-T performs prostate MRIs in addition to prostate biopsies every one to three years to ensure that patients continue to remain good candidates for active surveillance.
Most importantly, he will also follow PSA closely, but unless a PSA jumps above 10, or if it doubles, it does not give us much information about your prostate cancer. Dr. B-T will still follow the PSA, but he will be looking for big swings. Try not to get PSA anxiety because the PSA goes up or down. The biopsies and the MRI will give us the most information about the state of your prostate and whether a new, higher-grade lesion has developed.
It is completely understandable to be concerned about simply following cancer. Remember, though, that not all prostate cancer behaves the same. The intermediate- and higher-grade disease grows faster and can spread outside of the prostate and into the lymph nodes and bones.
Most patients with intermediate — and certainly patients with higher-grade — cancers are not good candidates for active surveillance. The risk of the cancer growing is higher in these patients, and early intervention is usually a better option.
Active surveillance is not forgetting about the cancer; it’s monitoring it to make sure we don’t see any changes. Dr. B-T follows a protocol that requires an MRI and repeat prostate biopsy within the first year after the diagnosis and then every one to three years thereafter. This is primarily to look for other cancers that may be present. Dr. Rich Bevan-Thomas is rarely worried about the Gleason 3 cancer (assuming it does not have aggressive features), but he is worried about the Gleason 4 or 5 disease that could be lurking nearby in other areas of the prostate.
With some men, even though they have low-grade prostate cancer, the anxiety associated with following the cancer outweighs the benefits of not treating the disease. You will have the option to treat your cancer at any time. Some men opt to treat their cancer earlier in the process for peace of mind or when they are younger and are still candidates for a robotic prostatectomy, as an example.
Either way, Dr. Rich Bevan-Thomas will sit down with you and your loved ones and explain all of the options and the associated risks and benefits to help you make the best decision for your individual cancer.